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- Side effects:
- drowsiness, slurred speech, headache, mental confusion, disorientation, nystagmus, ataxia, agitation, sleep disturbances (changes in REM sleep), hangover, oversedation
- Think alcohol, and don't use it.
- Most if not all can be habit forming.
- Many sleep aids are benzo derivatives.
- Can cause cleft lip/pallet to fetus during 1st trimester.
- Cx for elderly with sundowners. May-->psychotic episodes.
Increases GABA released-->v cranial activity --> calmness.
What do you need to monitor when pt is on benzos.
- Monitor for oversedation side effects: slurred speech, sleeping, drowsiness.
- Teach clients not to use alcohol which can potentiate the effects of valium.
- Increased risk for congenital anomalies in the 1st trimester. Use with caution in women who become pregnant or who are pregnant.
- It is excreted in breast milk and should be used with caution in nursing mothers.
- Do not take with MAO inhibitors
- Antacids may delay the absorption.
- Used with caution in the elderly. Lower doses (one half to one third) should be
- Slow IV administration of benzodiazepines. Valium/diazepam = 1 mg./minute.
- For IM administration, give deeply in muscle to eliminate irritation.
- PRN administration is preferable to regularly scheduled doses because of the tendency for addiction to occur. Even a 6 month course of taking Xanax/alprazolam can cause difficulty when trying to get patients off. The agitation and anxiety prevent some from wanting to quit taking the medication.
- Tapering is a safe way to discontinue because of risk for seizures.
Benzodiazepine Antagonist (Flumazenil)
- Side Effects: Drowsiness
- Use: Short-term management of anxiety and sleep
- Action: Depresses subcortical centers. Has no dependence, tolerance or intoxication. Can be used for indefinite periods and with patients who abuse substances.
- Nursing implications: Give Vistaril deep IM using Z-track method
Non-benzodiazepine Antianxiety Agent: Buspirone (BuSpar)
Be aware that another Rx has a very similar name.
- Side effects: Headache, blurred vision, numbness, dizziness, excitement, feeling angry, nervousness, hostile behavior, nausea, and/or CHF.
- Uses: Generalized anxiety disorders, can be used to treat anxiety in medically compromised clients such as those who have asthma or COPD.
- Action: Stimulates serotonin release from sending cells to synaptic clefts.
Nursing implication of using buspirone?
- Alleviates anxiety and does not appear to have an addition potential.
- Requires 2 weeks to reach a therapeutic blood level. Teach clients to continue taking it and they may not feel better as soon.
- Cannot eat grapefruit or drink grapefruit juice when taking buspirone.
Beta Blockers for anxiety
- Side effects: Decreased sexual ability, drowsiness, difficulty sleeping, weakness, unusual tiredness.
- Action: Blocks peripheral and central norepinephrine activity which blocks the fight or flight response.
- Indications: Blood pressure must be high enough to take it.
- Uses: Anxiety, GAD, PTSD, stage flight, migraine headaches
Rx for OCD?
- Fluvoxamine (Luvox) SSRI (blocks the reuptake of serotonin)
- Side effects: Nausea, nervousness, drowsiness, insomnia, worsening of seizures
Mechanism of Action: Its precise mechanism of action is unknown for OCD, but its ability to block the reuptake of serotonin (5-HT) is believed to be important.
Anticholenergic effects = "No see, no pee, no spit, no shit."